Cognition, 50 (1994) 115-132 OOlO-0277/94/$07.00 0 1994 - Elsevier Science B.V. All rights reserved.

Autism: beyond “theory of mind”

Uta Frith*, Francesca Happe

MRC Cognitive Development Unit, 4 Taviton Street, London WClH UBT, UK

Abstract

The theory of mind account of autism has been remarkably successful in making specific predictions about the impairments in socialization, imagination and communication shown by people with autism. It cannot, however, explain either the non-triad features of autism, or earlier experimental findings of abnormal assets and deficits on non-social tasks. These unexplained aspects of autism, and the existence of autistic individuals who consistently pass false belief tasks, suggest that it may be necessary to postulate an additional cognitive abnormality. One possible abnormality - weak central coherence - is discussed, and preliminary evidence for this theory is presented.

The theory of mind account of autism

In 1985 Cognition published an article by Baron-Cohen, Leslie, and Frith,

entitled: Does the autistic child have a “theory of mind”? The perceptive reader

would have recognized this as a reference to Premack and Woodruff’s (1978)

question: Does the chimpanzee have a theory of mind? The connection between

these two was, however, an indirect one -the immediate precursor of the paper

was Wimmer and Perner’s (1983) article on the understanding of false beliefs by

normally developing pre-school children. Each of these three papers has, in its

way, triggered an explosion of research interest; in the social impairments of

autism, the mind-reading capacities of non-human primates, and the development

of social understanding in normal children. The connections which existed

between the three papers have been mirrored in continuing connections between

these three fields of research - developmental psychology (Astington, Harris, &

Olson, 1989; Perner, 1991; Russell, 1992; Wellman, 1990), cognitive ethology

*Corresponding author

SSDI 0010-0277(93)00591-T

(Byrne 8: Whiten. 198X; Chency & Seyfarth, lYYO), and developmental psycho-

pathology (Cicchetti 6i Cohen, in press; Rutter, lY87). There can be little doubt

that these contacts have enriched work in each area.

Perceptive readers would also have noticed the inverted commas surrounding

the phrase “theory of mind” in the 1985 paper. Baron-Cohen. Leslie, and Frith

followed Premack and Woodruff’s definition of this “sexy” but misleading phrase:

to have a theory of mind is to be able to attribute independent mental states to

self and others in order to explain and predict behaviour. As might befit a

“theory” ascribable to chimpanzees. this was not a conscious theory but an

innately given cognitive mechanism allowing a special sort of representation - the

representation of mental states. Leslie (lYX7, 198X) delivered the critical con-

ncction between social understanding and understanding of pretence, via this

postulated mechanism: metareprescntation is necessary. in Leslie’s theory, for

rcprescnting prctcnce, belief and other mental states. From this connection,

between the social world and the world of imaginative play, sprung the link to

autistic children, who are markedly deficient in both areas.

The idea that people with autism could be characterized as suffering from a

type of “mind-blindness”, or lack of theory of mind. has been useful to the study

of child development - not because it was correct (that is still debatable) but

because it was a causal account which was both specific and fulsijiahle. The

clearest expression of this causal account is given in Frith, Morton. and Leslie

(1YYl). What is to be explained? Autism is currently defined at the behavioural

level, on the basis of impairments in socialization. communication and imagina-

tion, with stcrcotyped repetitive interests taking the place of creative play

(DSM-III-R, American Psychological Association, 1987). A causal account must

link these bchavioural symptoms to the presumed biological origins (Gillberg bi

Coleman, lYY2; Schopler bi Mesibov, 1087) of this disorder.

Specificity is particularly important in any causal account of autism because

autistic people themselves show a highly specific pattern of deficits and skills. The

IQ profile alone serves to demonstrate this; autistic people in general show an

unusually “spiky” prolile across Wechsler subtests (Lockyer & Rutter. 1970;

Tymchuk, Simmons, & Ncafscy. lY77). excelling on Block Design (constructing a

pattern with cubes). and failing on Picture Arrangement (ordering pictures in a

cartoon strip). This puzzling discrepancy of functioning has caused many previous

psychological theories of autism to fail. For example. high arousal. lack of

motivation, language impairment. or pcrccptual problems arc all too global to

allow for both the assets and deficits of autism.

Fine cuts along a hidden seam

What are the specific predictions made by the hypothesis that people with

autism lack a “theory of mind”‘? The hypothesis does not address the question of

Ii. Frith, F. HappC I Cognition SO (1994) 115-132 117

the spiky IQ profile - it is silent on functioning in non-social areas - but it focuses

on the critical triad of impairments (Wing & Gould, 1979). Not only does it make

sense of this triad, but it also makes “fine cuts” within the triad of autistic

impairments. Social and communicative behaviour is not all of one piece, when

viewed from the cognitive level. Some, but not all, such behaviour requires the

ability to “mentalize” (represent mental states). So, for example, social approach

need not be built upon an understanding of others’ thoughts-indeed Hermelin

and O’Connor (1970) demonstrated to many people’s initial surprise that autistic

children prefer to be with other people, just like non-autistic children of the same

mental age. However, sharing attention with someone else does require

mentalizing - and is consistently reported by parents to be missing in the

development of even able autistic children (Newson, Dawson, & Everard, 1984).

The mentalizing-deficit account has allowed a systematic approach to the

impaired and unimpaired social and communicative behaviour of people with

autism. Table 1 shows some of the work exploring predictions from the hypothesis

that autistic people lack mentalizing ability. The power of this hypothesis is to

make fine cuts in the smooth continuum of behaviours, and in this it has been

remarkably useful. It has sparked an enormous amount of research, both

supporting and attacking the theory (reviewed by Baron-Cohen, Tager-Flusberg,

& Cohen, 1993; Happe, 1994a; Happe & Frith, in press).

The fine cuts method, as used in the laboratory, has also informed research

1. Autistic assets and dejicits as predicted by the “fine cuts” technique,

between tasks which require mentalizing and those which do not

Assets

Ordering behavioural pictures

Understanding see

Protoimperative pointing

Sabotage

False photographs

Recognizing happiness and sadness

Object occlusion

Literal expression

Deficits

Ordering mentalistic pictures

(Baron-Cohen et al.. 1986)

Understanding know

(Perner et al., 1989)

Protodeclarative pointing

(Baron-Cohen, lY8Yb)

Deception

(Sodian & Frith, lYY2)

False beliefs

(Leslie & Thaiss, 1902;

Leekam & Perner, IYYl) Recognizing surprise

(Baron-Cohen et al.. 1993)

Information occlusion (Baron-Cohen, 1992)

Metaphorical expression

(Happt. 1993)

References refer to Assets and Deficits

11X Li. Frifh. F. Happt I Cogrlition -50 (lYY4) 11.5-132

Table 2. Autistic assets and deficits observed in real life

Assets

Elicited structured play

Instrumental gestures

Talking about desires and emotions

Using person as tool

Showing “active” sociability

Deficits

Spontaneous pretend play

(Wetherby & Prutting. 1984) Expressive gestures

(Attwood. Frith, & Hermelin, 1988)

Talking about beliefs and ideas (Tager-Flusberg. 1993)

Using person as receiver of information (Phillips. 1993)

Showing “interactive” sociability (Frith et al., in press)

References refer to Assets and Deficits.

into the pattern of abilities and deficits in real life (Table 2), although this

enterprise has still some way to go. This technique, which aims to pit two

behaviours against each other which differ only in the demands they make upon

the ability to mentalize, pre-empts many potential criticisms. It is also peculiarly

suitable for use in brain-imaging studies. By looking at performance across tasks

which are equivalent in every other way, except for the critical cognitive

component, intellectual energy has been saved for the really interesting theoret-

ical debates.

Another key benefit of the specificity of this approach is the relevance it has for

normal development. The fine cuts approach suits the current climate of increased

interest in the modular nature of mental capacities (e.g., Cosmides, 1989; Fodor,

1983). It has allowed us to think about social and communicative behaviour in a

new way. For this reason, autism has come to be a test case for many theories of

normal development (e.g., Happe, 1993; Sperber & Wilson’s 1986 Relevance

theory).

Limitations of the theory of mind account

The hijacking of autism by those primarily interested in normal development

has added greatly to the intellectual richness of autism research. But just how well

does the theory of mind account explain autism ? By the stringent standard. that

explanatory theories must give a fd account of a disorder (Morton & Frith, in

press), not that well. The mentalizing account has helped us to understand the

nature of the autistic child’s impairments in play, social interaction and verbal and

non-verbal communication. But there is more to autism than the classic triad of

impairments.

U. Frith, F. Happk I Cognition 50 (1994) 115-132 119

Non-triad features

Clinical impressions, originating with Kanner (1943) and Asperger

(1944; translated in Frith, 1991), and withstanding the test of time, include the

following:

_ Restricted repertoire of interests (necessary for diagnosis in DSM-III-R,

American Psychological Association, 1987).

- Obsessive desire for sameness (one of two cardinal features for Kanner &

Eisenberg, 1956).

- Islets of ability (an essential criterion in Kanner, 1943).

- Idiot savant abilities (striking in 1 in 10 autistic children, Rimland & Hill,

1984).

- Excellent rote memory (emphasized by Kanner, 1943). _ Preoccupation with parts of objects (a diagnostic feature in DSM-IV, forthcom-

ing).

All of these non-triad aspects of autism are vividly documented in the many

parental accounts of the development of autistic children (Hart, 1989; McDon-

nell, 1993; Park, 1967). None of these aspects can be well explained by a lack of

mentalizing.

Of course, clinically striking features shown by people with autism need not be

specific features of the disorder. However, there is also a substantial body of

experimental work, much of it predating the mentalizing theory, which dem-

onstrates non-social abnormalities that are specific to autism. Hermelin

and O’Connor were the first to introduce what was in effect a different “fine

cuts” method (summarized in their 1970 monograph) -namely the com-

parison of closely matched groups of autistic and non-autistic handicapped

children of the same mental age. Table 3 summarizes some of the relevant find-

ings.

The talented minority

The mentalizing deficit theory of autism, then, cannot explain all features of

autism. It also cannot explain all people with autism. Even in the first test of the

hypothesis (reported in the 1985 Cognition paper), some 20% of autistic children

passed the Sally-Ann task. Most of these successful children also passed another

test of mentalizing - ordering picture stories involving mental states (Baron-

Cohen, Leslie, & Frith, 1986) - suggesting some real underlying competence in

representing mental states. Baron-Cohen (1989a) tackled this apparent dis-

Table 3. Experimental findings not accounted for by mind-blindness. Surprising

advantuges and disadvantuges on cognitive tasks, .shown by autistic

subjects relative to normally expected usymmetries

Unusual strength

Memory for word strings

Memory for unrelated items

Echoing nonsense

Pattern imposition

Jigsaw hy shape

Sorting faces by accessoria

Recognizing faces upside-down

Unusual weakness

Memory for sentences

(e.g., Hermelin Kr O’Connor. lY67)

Memory for related items

(e.g.. Tager-Flusberg. 1YYl)

Echoing with repair

(e.g.. Aurnhammcr-Frith. 196’))

Pattern detection

(e.g.. Frith. 1970 a.b)

Jigsaw hy picture

(e.g.. Frith & Hermelin. lY6Y)

Sorting faces hy person

(e.g., Weeks & Hobson, 19X7)

Recognizing faces right-way-up

(e.g., Langdell. lY7X)

References refer to Unusual strength and Unusual weakness

confirmation of the theory, by showing that these talented children still did not

pass a harder (second-order) theory of mind task (Perner & Wimmer, 1985).

However, results from other studies focusing on high-functioning autistic subjects

(Bowler, 1992; Ozonoff, Rogers. & Pennington, 1991) have shown that some

autistic people can pass theory of mind tasks consistently, applying these skills

across domains (Happe, 1993) and showing evidence of insightful social be-

haviour in everyday life (Frith, Happe, & Siddons. in press). One possible way of

explaining the persisting autism of these successful subjects is to postulate an

additional and continuing cognitive impairment. What could this impairment be‘?

The recent interest in executive function deficits in autism (Hughes 6i Russell,

1993; Ozonoff. Pennington, & Rogers, 1991) can be seen as springing from some

of the limitations of the theory of mind view discussed above. Ozonoff. Rogers, &

Pennington (1991) found that while not all subjects with autism and/or Aspcr-

ger’s syndrome showed a theory of mind deficit. all were impaired on the

Wisconsin Card Sorting Test and Tower of Hanoi (two typical tests of executive

function). On the basis of this finding they suggest that executive function

impairments arc a primary causal factor in autism. However, the specificity, and

hence the power of this theory as a causal account. has yet to be established by

systematic comparison with other non-autistic groups who show impairments in

executive functions (Bishop, 1993). While an additional impairment in executive

functions may be able to explain certain (perhaps non-specific) features of autism

(e.g., stereotypies, failure to plan, impulsiveness). it is not clear how it could

explain the specific deficits and skills summarized in Table 3.

Ii. Fribh, F. Happk I Cognition .50 (1994) 1 IS-132 121

The central coherence theory

Motivated by the strong belief that both the assets and the deficits of autism

spring from a single cause at the cognitive level, Frith (1989) proposed that

autism is characterized by a specific imbalance in integration of information at

different levels. A characteristic of normal information processing appears to be

the tendency to draw together diverse information to construct higher-level

meaning in context; “central coherence ” in Frith’s words. For example, the gist of

a story is easily recalled, while the actual surface form is quickly lost, and is

effortful to retain. Bartlett (1932), summarizing his famous series of experiments

on remembering images and stories, concluded: “an individual does not normally

take [such] a situation detail by detail . . . In all ordinary instances he has an

overmastering tendency simply to get a general impression of the whole; and, on

the basis of this, he constructs the probable detail” (p. 206). Another instance of

central coherence is the ease with which we recognize the contextually appro-

priate sense of the many ambiguous words used in everyday speech (son-sun,

meet-meat, sew-so, pear-pair). A similar tendency to process information in

context for global meaning is also seen with non-verbal material - for example,

our everyday tendency to misinterpret details in a jigsaw piece according to the

expected position in the whole picture. It is likely that this preference for higher

levels of meaning may characterize even mentally handicapped (non-autistic)

individuals - who appear to be sensitive to the advantage of recalling organized

versus jumbled material (e.g., Hermelin & O’Connor, 1967).

Frith suggested that this universal feature of human information processing was

disturbed in autism, and that a lack of central coherence could explain very

parsimoniously the assets and deficits shown in Table 3. On the basis of this

theory, she predicted that autistic subjects would be relatively good at tasks where

attention to local information - relatively piece-meal processing - is advantage-

ous, but poor at tasks requiring the recognition of global meaning.

Empirical evidence: assets

A first striking signpost towards the theory appeared quite unexpectedly, when

Amitta Shah set off to look at autistic children’s putative perceptual impairments

on the Embedded Figures Test. The children were almost better than the

experimenter! Twenty autistic subjects with an average age of 13, and non-verbal

mental age of 9.6, were compared with 20 learning disabled children of the same

age and mental age, and 20 normal 9-year-olds. These children were given the

Children’s Embedded Figures Test (CEFI; Witkin, Oltman, Raskin, & Karp,

1971), with a slightly modified procedure including some pretraining with cut-out

shapes. The test involved spotting a hidden figure (triangle or house shape)

among a larger meaningful drawing (e.g.. a clock). During testing children were

allowed to indicate the hidden figure either by pointing or by using a cut-out

shape of the hidden figure. Out of a maximum score of 25, autistic children got a

mean of 21 items correct, while the two control groups (which did not differ

significantly in their scores) achieved 15 or less. Gottschaldt (1026) ascribed the

difficulty of finding embedded tigures to the overwhelming “predominance of the

whole”. The ease and speed with which autistic subjects picked out the hidden

figure in Shah and Frith’s (1983) study was reminiscent of their rapid style of

locating tiny objects (c.g. thread on a patterned carpet) and their immediate

discovery of minute changes in familiar lay-outs (e.g.. arrangement of cleaning

materials on bathroom shelf), as often described anecdotally.

The study of embedded figures was introduced into experimental psychology

by the Gestalt psychologists, who believed that an effort was needed to resist the

tendency to see the forcefully created gestalt. at the expense of the constituent

parts (Koffka, 1935). Perhaps this struggle to resist overall gestalt forces does not

occur for autistic subjects. If people with autism. due to weak central coherence,

have privileged access to the parts and details normally securely embedded in

whole figures. then novel predictions could be made about the nature of their

islets of ability.

The Block Design subtest of the Wechsler Intelligence Scales (Wechsler, 1974,

1981) is consistently found to be a test on which autistic people show superior

performance relative to other subtests. and often relative to other people of the

same age. This test. first introduced by Kohs (1923), requires the breaking up of

line drawings into logical units, so that individual blocks can be used to

reconstruct the original design from separate parts. The designs are notable for

their strong gestalt qualities , and the difficulty which most people experience with

this task appears to relate to problems in breaking up the whole design into the

constituent blocks. While many authors have rccognizcd this subtest as an islet of

ability in autism, this fact has generally been explained as due to intact or superior

general spatial skills (Lockycr & Kutter, 1070: Prior, 1979). Shah and Frith

( 1993) suggested, on the basis of the central coherence theory, that the advantage

shown by autistic subjects is due specifically to their ability to see parts over

wholes. They predicted that normal, but not autistic. subjects would benefit from

pre-segmentation of the designs.

Twenty autistic. 33 normal and 12 learning disabled subjects took part in an

experiment, where 40 different block designs had to be constructed from either

whole or pre-segmented drawn models (Fig. 1). Autistic subjects with normal or

near-normal non-verbal IQ were matched with normal children of 16 years.

Autistic subjects with non-verbal IQ below X5 (and not lower than 57) were

compared with learning disabled children of comparable IQ and chronological age

(I8 years), and normal children aged 10. The results showed that the autistic

subjects’ skill on this task resulted from a greater ability to segment the design.

Autistic subjects showed superior performance compared to controls in one

U. Frith. F. HappP I Cognition SO (1994) 115-132 123

Fig. 1. Examples of all types of design: “whole” versus “segmented” (I, 2. 3. 4 vs. 5, 6, 7. 8) “oblique” versus “non-oblique” (3, 4. 7. X vs. 1, 2, 5. 6) “unrotuted” WKWS “rotated” (1. 3, 5. 7 vs. 2, 4. 6. 8).

condition only - when working from whole designs. The great advantage which

the control subjects gained from using pre-segmented designs was significantly

diminished in the autistic subjects, regardless of their IQ level. On the other

hand, other conditions which contrasted presence and absence of obliques, and

rotated versus unrotated presentation, affected all groups equally. From these

latter findings it can be concluded that general visuo-spatial factors show perfectly

normal effects in autistic subjects, and that superior general spatial skill may not

account for Block design superiority.

Empirical evidence: deficits

While weak central coherence confers significant advantages in tasks where

preferential processing of parts over wholes is useful, it would be expected to

confer marked disadvantages in tasks which involve interpretation of individual

124 U. Frirh, F. HuppP I Cognition SO (1994) IlJ-I.31

stimuli in terms of overall context and meaning. An interesting example is the

processing of faces, which seems to involve both featural and configural process-

ing (Tanka & Farah, 1993). Of these two types of information, it appears to be

configural processing which is disrupted by the inverted presentation of faces

(Bartlett 6i Searcy, 1993; Rhodes, Brake, & Atkinson, 1993). This may explain

the previously puzzling finding that autistic subjects show a diminished dis-

advantage in processing inverted faces (Hobson, Ouston, & Lee, 1988; Langdell.

1978).

One cast in which the meaning of individual stimuli is changed by their context

is in the disambiguation of homographs. In order to choose the correct (context-

appropriate) pronunciation in the following sentences, one must process the final

word as part of the whole sentence meaning: “He had a pink ~OMJ”; “He made a

deep baw”. Frith and Snowling (1983) predicted that this sort of contextual

disambiguation would be problematic for people with autism. They tested X

children with autism who had reading ages of 8-10 years, and compared them

with 6 dyslexic children and 10 normal children of the same reading age. The

number of words read with the contextually appropriate pronunciation ranged

from 5 to 7 out of 10 for the autistic children. who tended to give the more

frequent pronunciation regardless of sentence context. By contrast. the normal

and dyslexic children read between 7 and 9 of the 10 homographs in a

contextually determined manner. This finding suggested that autistic children,

although excellent at decoding single words, were impaired when contextual cues

had to be used. This was also demonstrated in their relative inability to answer

comprehension questions and to fill in gaps in a story text. This work fits well with

previous findings (Table 3) concerning failure to use meaning and redundancy in

memory tasks.

The abnormality of excellence

The hypothesis that people with autism show weak central coherence aims to

explain both the glaring impairments and the outstanding skills of autism as

resulting from a single characteristic of information processing. One characteristic

of this theory is that it claims that the islets of ability and savant skills are

achieved through relatively abnormal processing, and predicts that this may be

revealed in abnormal error patterns. One example might be the type of error

made in the Block Design test. The central coherence theory suggests that, where

errors are made at all on Block Design, these will be errors which violate the

overall pattern, rather than the details. Kramer, Kaplan, Blusewicz, and Preston

(1991) found that in normal adult subjects there was a strong relation between the

number of such configuration-breaking errors made on the Block Design test and

the number of local (vs. global) choices made in a similarity-judgement task

U. Frith, F. Happk I Cognition 50 (lYY4) 115-132 125

(Kimchi & Palmer, 1982). Preliminary data from subjects with autism (Happe, in

preparation) suggest that, in contrast to normal children, errors violating configu-

ration are far more common than errors violating pattern details in autistic Block

Design performance.

A second example concerns idiot savant drawing ability. Excellent drawing

ability may be characterized by a relatively piece-meal drawing style. Mottron and

Belleville (1993) found in a case study of one autistic man with exceptional artistic

ability that performance on three different types of tasks suggested an anomaly in

the hierarchical organization of the local and global parts of figures. The authors

observed that the subject “began his drawing by a secondary detail and then

progressed by adding contiguous elements”, and concluded that his drawings

showed “no privileged status of the global form . . . but rather a construction by

local progression”. In contrast, a professional draughtsman who acted as a control

started by constructing outlines and then proceeded to parts. It remains to be seen

whether other savant abilities can be explained in terms of a similarly local and

detail-observant processing style.

Central coherence and mentalizing

Central coherence, then, may be helpful in explaining some of the real-life

features that have so far resisted explanation, as well as making sense of a body of

experimental work not well accounted for by the mentalizing deficit theory. Can it

also shed light on the continuing handicaps of those talented autistic subjects who

show consistent evidence of some mentalizing ability? Happe (1991), in a first

exploration of the links between central coherence and theory of mind, used

Snowling and Frith’s (1986) homograph reading task with a group of able autistic

subjects. Autistic subjects were tested on a battery of theory of mind tasks at two

levels of difficulty (first- and second-order theory of mind), and grouped

according to their performance (Happe, 1993). Five subjects who failed all the

theory of mind tasks, 5 subjects who passed all and only first-order tasks, and 6

subjects who passed both first- and second-order theory of mind tasks were

compared with 14 7-8-year-olds. The autistic subjects were of mean age 18 years,

and had a mean IQ of around 80. The three autistic groups and the control group

obtained the same score for total number of words correctly read. As predicted,

however, the young normal subjects, but not the autistic subjects, were sensitive

to the relative position of target homograph and disambiguating context: “There

was a big tear in her eye”, versus “In her dress there was a big tear”. The normal

controls showed a significant advantage when sentence context occurred before

(rare pronunciation) target words (scoring 5 out of 5, vs. 2 out of 5 where target

came first), while the autistic subjects (as in Frith and Snowling, 1983) tended to

give the more frequent pronunciation regardless (3 out of 5 appropriate pronun-

126 U. Frirh. F. HuppP I C‘ognirion SO (1994) ll.C-I.Z.?

ciations in each case). The important point of this study was that this was true of

all three autistic groups, irrespective of level of theory of mind performance.

Even those subjects who consistently passed all the theory of mind tasks (mean

VIQ 90) failed to use sentence context to disambiguate homograph pronuncia-

tion. It is possible, therefore, to think of weak central coherence as characteristic

of even those autistic subjects who possess some mentalizing ability.

Happe (submitted) explored this idea further by looking at WISC-R and WAIS

subtest profiles. Twenty-seven children who failed standard first-order false belief

tasks were compared with 21 subjects who passed. In both groups Block Design

was a peak of non-verbal performance for the majority of subjects: 18121 passers,

and 23/27 failers. In contrast. performance on the Comprehension subtest

(commonly thought of as requiring pragmatic and social skill) was a low point in

verbal performance for 13/ 17 “failers” but only 6120 “passers”. It seems, then,

that while social reasoning difficulties (as shown by Wechsler tests) are striking

only in those subjects who fail theory of mind tasks, skill on non-verbal tasks

benefiting from weak central coherence is characteristic of both passers and

failers.

There is, then, preliminary evidence to suggest that the central coherence

hypothesis is a good candidate for explaining the persisting handicaps of the

talented minority. So, for example, when theory of mind tasks were embedded in

slightly more naturalistic tasks, involving extracting information from a story

context, even autistic subjects who passed standard second-order false belief tasks

showed characteristic and striking errors of mental state attribution (Happe.

1994b). It may be that a theory of mind mechanism which is not fed by rich and

integrated contextual information is of little use in everyday life.

The finding that weak central coherence may characterize autistic people at all

levels of theory of mind ability goes against Frith’s (1989) original suggestion that

a weakness in central coherence could by itself account for theory of mind

impairment. At present, all the evidence suggests that we should retain the idea

of a modular and specific mentalizing deficit in our causal explanation of the triad

of impairments in autism. It is still our belief that nothing captures the essence of

autism so precisely as the idea of “mind-blindness”. Nevertheless, for a full

understanding of autism in all its forms, this explanation alone will not suffice.

Therefore, our present conception is that there may be two rather different

cognitive characteristics that underlie autism. Following Leslie (1987, 1988) we

hold that the mentalizing deficit can be usefully conceptualized as the impairment

of a single modular system. This system has a neurological basis - which may be

damaged, leaving other functions intact (e.g., normal IQ). The ability to

.mentalize would appear to be of such evolutionary value (Byrne & Whiten, 1988;

Whiten, 1991) that only insult to the brain can produce deficits in this area. By

contrast, the processing characteristic of weak central coherence, as illustrated

above, gives both advantages and disadvantages, as would strong central coher-

ence. It is possible, then. to think of this balance (between preference for parts

U. Frith, F. Happa / Cognition 50 (1994) 115-132 127

vs. wholes) as akin to a cognitive style, which may vary in the normal population.

No doubt, this style would be subject to environmental influences, but, in

addition, it may have a genetic component. It may be interesting, then, to focus

on the strengths and weaknesses of autistic children’s processing, in terms of weak

central coherence, in looking for the extended phenotype of autism. Some initial

evidence for this may be found in the report by Landa, Folstein, and Isaacs

(1991) that the parents of children with autism tell rather less coherent sponta-

neous narratives than do controls.

Central coherence and executive function

With the speculative link to cognitive style rather than straightforward deficit,

the central coherence hypothesis differs radically not only from the theory of

mind account, but also from other recent theories of autism. In fact, every other

current psychological theory claims that some significant and objectively harmful

deficit is primary in autism. Perhaps the most influential of such general theories

is the idea that autistic people have executive function deficits, which in turn

cause social and non-social abnormalities. The umbrella term “executive func-

tions” covers a multitude of higher cognitive functions, and so is likely to overlap

to some degree with conceptions of both central coherence and theory of mind.

However, the hypothesis that autistic people have relatively weak central

coherence makes specific and distinct predictions even within the area of

executive function. For example, the “inhibition of pre-potent but incorrect

responses” may contain two separable elements: inhibition and recognition of

context-appropriate response. One factor which can make a pre-potent response

incorrect is a change of context. If a stimulus is treated in the same way regardless

of context, this may look like a failure of inhibition. However, autistic people may

have no problem in inhibiting action where context is irrelevant. Of course it may

be that some people with autism do have an additional impairment in inhibitory

control, just as some have peripheral perceptual handicaps or specific language

problems.

Future prospects

The central coherence account of autism is clearly still tentative and suffers

from a certain degree of over-extension. It is not clear where the limits of this

theory should be drawn - it is perhaps in danger of trying to take on the whole

problem of meaning! One of the areas for future definition will be the level at

which coherence is weak in autism. While Block Design and Embedded Figures

tests appear to tap processing characteristics at a fairly low or perceptual level,

12x U. Frith, I*‘. HqpP i Chgnition SO (1994) 115L I.32

work on memory and verbal comprehension suggests higher-level coherence

deficits. Coherence can be seen at many levels in normal subjects, from the global

precedence effect in perception of hierarchical figures (Navon, 1977) to the

synthesis of large amounts of information and extraction of inferences in narrative

processing (e.g.. Trabasso & Suh, 1993. in a special issue of Discourse Processes

on inference generation during text comprehension). One interesting way forward

may be to contrast local coherence within modular systems, and global coherence

across these systems in central processing. So, for example, the calendrical

calculating skills of some people with autism clearly show that information within

a restricted domain can be integrated and processed together (O’Connor &

Hermelin, 1984; Hermelin & O’Connor, 1986), but the failure of many such

savants to apply their numerical skills more widely (some cannot multiply two

given numbers) suggests a modular system specialized for a very narrow cognitive

task. Similarly, Norris (1990) found that building a connectionist model of an

“idiot savant date calculator” only succeeded when forced to take a modular

approach.

Level of coherence may be relative. So, for example, within text there is the

word-to-word effect of local association, the effect of sentence context, and the

larger effect of story structure. These three levels may be dissociable, and it may

be that people with autism process the most local of the levels available in

open-ended tasks. The importance of testing central coherence with open-ended

tasks is suggested by a number of findings. For example, Snowling and Frith

(1986) demonstrated that it was possible to train subjects with autism to give the

context appropriate (but less frequent) pronunciation of ambiguous homographs.

Weeks and Hobson (1987) found that autistic subjects sorted photographs of faces

by type of hat when given a free choice. but, when asked again, were able to sort

by facial expression. It seems likely, then, that autistic weak central coherence is

most clearly shown in (non-conscious) processing preference, which may reflect

the relative cost of two types of processing (relatively global and meaningful vs.

relatively local and piece-meal).

Just as the idea of a deficit in theory of mind has taken several years and

considerable (and continuing) work to be empirically established, so the idea of a

weakness in central coherence will require a systematic programme of research.

Like the theory of mind account, it is to be hoped that, whether right or wrong,

the central coherence theory will form a useful framework for thinking about

autism in the future.

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